Brain Metastases

Brain metastases are tumors that have spread to the brain from a cancer that started somewhere else — most commonly lung, breast, melanoma, kidney, or colorectal. They are far more common than primary brain tumors and the management has changed substantially over the past decade.

Modern systemic therapy (targeted agents, immunotherapy), modern radiation (stereotactic radiosurgery), and modern surgery have meaningfully extended both survival and quality of life for many patients. The right plan is individualized — single large lesion, multiple small lesions, deep eloquent location, and the status of your primary cancer all matter.

Care is collaborative from day one. I work closely with your medical oncologist, radiation oncologist, and primary-disease team to assemble the right plan. The decision is rarely surgery in isolation — it is surgery as one piece of an overall strategy.

For symptomatic single lesions in surgically accessible locations, resection plus stereotactic radiosurgery to the resection cavity is often the right answer. For multiple small lesions, radiosurgery alone may be preferred. For lesions causing significant mass effect or in critical locations, the decision becomes more nuanced.

When surgery is the right move, we use navigation, intraoperative imaging, and — for lesions near eloquent cortex — awake mapping to maximize safe resection. Recovery is meaningful but typically faster than primary brain tumor surgery because the surrounding brain is usually healthier.

Surgery is considered for a single accessible lesion causing mass effect or symptoms, for tissue diagnosis when the primary cancer is unknown, or for lesions that radiation alone may not control.

The goal of surgery in brain metastases is to relieve symptoms immediately, provide a tissue diagnosis when needed, and enable other treatments to work effectively. Combined with radiation and systemic therapy, surgery can meaningfully extend both survival and quality of life.